Tuesday, January 21, 2014

"The Dark Side of the Sun": The Problem with Disclosure

"The Dark Side of the Sun" is the cute title of a 2011 paper in BMJ co-authored by Canadian bioethicist Mark Wilson. Wilson is now back:http://www.openmedicine.ca/article/view/628/534
--with a new short paper on the Sunshine Act that's part of the US Affordable Care Act and due to take effect later this year. Let's just say he's not a fan.

I've tried to take the position both in this blog and earlier in HOOKED that disclosure of conflict of interest is not enough by itself and we need to do all we can to eliminate COI. I have generally, however, supported Sunshine-type provisions as helpful steps in the right direction and especially as good tools for the few investigative journalists left these days, who have been able to use disclosures to piece together telling stories about physician misbehavior that in turn has probably exerted a useful chilling effect over too-comfy relationships with industry. Wilson's new paper raises the interesting question about whether the Sunshine Act, rather than being a partial step in a helpful direction, actually may do more harm than good.

Briefly, his case against disclosure policies is:

The current focus on disclosure as a cure-all has diverted critical institutional attention away from more meaningful (but difficult) COI reforms.

Wall Street provides an excellent example of the futility of disclosure. The COI's of the major accounting firms played a huge role in bringing about the Great Recession of 2008 (as I discuss briefly in my book, The Golden Calf). These firms proceeded to bestow triple-A ratings on worthless financial instruments while pocketing hefty fees from the purveyors of those instruments. The lobbyists for Wall Street have thus far fought off all attempts at real reform of this corrupt system, all the while acting as if mere disclosure solves things.

The Sunshine Act actually shifts the burden of "fixing" the COI problem off the shoulders of the institutions that might have the power and authority to do something, and onto the person with no power at all in the system, the individual consumer/patient.